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Castro L, Brant L, Diniz MDF, Lotufo P, Bensenor IJ, Chor D, Griep R, Barreto SM, Ribeiro AL. Association of hypertension and insulin resistance in individuals free of diabetes in the ELSA-Brasil cohort. Sci Rep 2023; 13:9456. [PMID: 37301876 PMCID: PMC10257662 DOI: 10.1038/s41598-023-35298-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/16/2023] [Indexed: 06/12/2023] Open
Abstract
Insulin resistance (IR) is defined as the subnormal response to insulin action on its target tissues. Studies suggest that IR may increase the risk of hypertension, but the results are inconsistent and it is not known whether such an effect is independent of overweight/obesity. We aimed to evaluate the association between IR and the incidence of prehypertension and hypertension in the Brazilian population and whether this association is independent of overweight/obesity. In 4717 participants of the Brazilian Longitudinal Study of Adult's Health (ELSA-Brasil), free of diabetes and cardiovascular disease at baseline (2008-2010), we investigated the incidence of prehypertension and hypertension after a mean follow-up of 3.8 ± 0.5 years. Insulin resistance at baseline was assessed by the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) index, defined if above the 75th percentile. The risk of IR-associated prehypertension/hypertension was estimated by multinomial logistic regression after adjustment for confounding factors. Secondary analysis were stratified by body mass index. The mean (SD) age of participants was 48 (8) years, 67% were women. The 75th percentile of HOMA-IR at baseline was 2.85. The presence of IR increased the chance of developing prehypertension by 51% (95% CI 1.28-1.79) and hypertension by 150% (95% CI 1.48-4.23). In individuals with BMI < 25 kg/m2, the presence of IR remained associated with the incidence of prehypertension (OR 1.41; 95% CI 1.01-1.98) and hypertension (OR 3.15; 95% CI 1.27-7.81). In conclusion, our results suggest that IR is a risk factor for hypertension, regardless of the presence of overweight or obesity.
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Affiliation(s)
- Luísa Castro
- Longitudinal Study of Adult Health - ELSA Brasil, Federal University of Minas Gerais, Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte, MG, 30130-100, Brazil
| | - Luísa Brant
- Longitudinal Study of Adult Health - ELSA Brasil, Federal University of Minas Gerais, Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte, MG, 30130-100, Brazil
| | - Maria de Fátima Diniz
- Longitudinal Study of Adult Health - ELSA Brasil, Federal University of Minas Gerais, Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte, MG, 30130-100, Brazil
| | - Paulo Lotufo
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - Isabela Judith Bensenor
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - Dora Chor
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Rosane Griep
- Laboratory of Education in Environment and Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Sandhi Maria Barreto
- Longitudinal Study of Adult Health - ELSA Brasil, Federal University of Minas Gerais, Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte, MG, 30130-100, Brazil
| | - Antonio Luiz Ribeiro
- Longitudinal Study of Adult Health - ELSA Brasil, Federal University of Minas Gerais, Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte, MG, 30130-100, Brazil.
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Liu T, Xuan H, Yin J, Wang L, Wang C, Xu X, Chen J, Li D, Xu T. Triglyceride Glucose Index Increases Significantly Risk of Hypertension Development in Chinese Individuals Aged ≥45 Years Old: Analysis from the China Health and Retirement Longitudinal Study. J Multidiscip Healthc 2023; 16:63-73. [PMID: 36660037 PMCID: PMC9842521 DOI: 10.2147/jmdh.s391905] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/07/2023] [Indexed: 01/13/2023] Open
Abstract
Objective Our purpose was to explore the relationship between triglyceride glucose (TyG) index and the risk of new-onset hypertension in Chinese individuals aged ≥45 years. Methods From 2011 to 2018, data from the China Health and Retirement Longitudinal Survey (CHARLS) were analyzed. The relationship between TyG index and hypertension was assessed utilizing Cox regression and restricted cubic spline (RCS) plot, and the importance of the TyG index in hypertension development was demonstrated by a random forest machine learning model. Finally, subgroup analysis was conducted to test for potential interactions on hypertension development between the TyG index and subgroups. Results 19.7% of the 4755 individuals who were involved in this survey developed hypertension over an average follow-up period of 5.22 years. Compared with the first quartile of albumin, the multivariate HR (95% CI) for the risk of new-onset hypertension across the TyG index quartiles was 1.09 (0.89, 1.33), 1.09 (0.89, 1.33), and 1.29 (1.06, 1.58), respectively (P for trend <0.001). The RCS plot revealed a linear relationship (P for nonlinear = 0.322), and the random forest machine learning model illustrated that the TyG index was a significant hazard factor on hypertension development. There was no interaction between subgroups and the relationships of the TyG index with the prevalence of hypertension (all P-value >0.05). Conclusion TyG index was an independent hazard indicator for new-onset hypertension, and routine measurement and control of TyG index level might be great for preventing hypertension development.
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Affiliation(s)
- Tao Liu
- Department of Cardiology, Jinshan Branch of Shanghai Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Haochen Xuan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Jie Yin
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Lili Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Chaofan Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Xianzhi Xu
- Department of Stomatology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Junhong Chen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Dongye Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Tongda Xu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China,Correspondence: Tongda Xu; Dongye Li, Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China, Email ;
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Cai Q, Xing CY, Zhu J, Wang Y, Lu F, Peng J. Associations between triglyceride-glucose index and different hypertension subtypes: A population-based study in China. Front Cardiovasc Med 2022; 9:901180. [PMID: 36035963 PMCID: PMC9408994 DOI: 10.3389/fcvm.2022.901180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Abnormal glycolipid metabolism plays a crucial role in hypertension. While an elevated triglyceride-glucose (TyG) index has been recognized as a risk factor for developing hypertension, the associations between the TyG index and different hypertension subtypes, namely, isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH), remain unclear. This study was designed to investigate the associations between the TyG index and hypertension subtypes in a general Chinese population. Materials and methods In a sample of 16,793 participants from Shandong Province, China, multivariate logistic regression analyses were performed to examine the associations between the TyG index and different hypertension subtypes. Loess smooth curves were fitted to visualize the trends. Stratified analyses were conducted to further assess the potential interactions in the associations between the TyG index and different hypertension subtypes. Results A higher TyG index was associated with an increased odds of having IDH (OR = 2.94, 95% CI: 1.66–5.23) and SDH (OR = 1.82, 95% CI: 1.33–2.49), whereas no apparent relationship was observed between TyG index and ISH. With respect to sex, the effect of TyG index on having IDH and SDH was significant in women, but not in men. Participants with lower lipid profiles and glucose levels demonstrated a stronger strength of association between the TyG index and IDH as compared with the TyG index-SDH association. Stratified analysis showed that participants with a higher TyG index were more than 3 times more likely to have IDH and SDH among persons aged 18–42 years. Significant interactions were observed between TyG index and sex, age, and high-density lipoprotein cholesterol (HDL-C) in the SDH group, and a significant interaction was also found between TyG index and body mass index (BMI) in the ISH group. Conclusion Triglyceride-glucose index may potentially serve as a novel indicator for IDH and SDH. Our findings could also inform the development and implementation of targeted screening for hypertension.
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Affiliation(s)
- Qian Cai
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Cathleen Y. Xing
- Tuberculosis Control and Prevention Program, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Jiang Zhu
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Ying Wang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Fanghong Lu
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jie Peng
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- *Correspondence: Jie Peng,
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Flores-Guerrero JL, Connelly MA, Shalaurova I, Garcia E, Bakker SJL, Dullaart RPF. A metabolomic index based on lipoprotein subfractions and branched chain amino acids is associated with incident hypertension. Eur J Intern Med 2021; 94:56-63. [PMID: 34321184 DOI: 10.1016/j.ejim.2021.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/25/2021] [Accepted: 07/10/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The present study aims to evaluate the performance of the Diabetes Risk Index (DRI), a metabolomic index based on lipoprotein particles and branched chain amino acids, on the incidence of newly developed hypertension in a large community dwelling cohort. METHODS The DRI was calculated by combining 6 lipoprotein parameters [sizes of very-low-density lipoprotein (VLDL), low-density lipoprotein (LDL) and high-density lipoprotein (HDL), concentrations of large VLDL, small LDL, and large HDL particles], and the concentrations of valine and leucine. DRI scores were estimated in 4169 participants from the PREVEND prospective cohort. Cox proportional hazards regression was used to evaluate the association of DRI scores with incident hypertension. RESULTS During a median follow-up of 8.6 years, 924 new hypertension cases were ascertained. In analyses adjusted for age and sex, there was a significant association between DRI and incident hypertension with a hazard ratio (HR) per 1 SD increase of 1.45 (95% CI 1.36,1.54; p < 0.001). After additional adjustment for traditional risk factors, the HR remained significant (HRadj 1.21, 95% CI 1.10, 1.33, p <0.001). Likewise, subjects in the top quartile of DRI presented with a higher risk of hypertension (HRadj 1.64, 95% CI 1.28, 2.10, p <0.001). Furthermore, the net reclassification improvement assessment improved after the addition of DRI to a traditional risk model (p <0.001), allowing proper reclassification of 34% of the participants. CONCLUSION Higher DRI scores were associated with an increased risk of incident hypertension. Such association was independent of traditional clinical risk factors for hypertension.
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Affiliation(s)
- Jose L Flores-Guerrero
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands..
| | - Margery A Connelly
- Laboratory Corporation of America Holdings (Labcorp), Morrisville, North Carolina, USA
| | - Irina Shalaurova
- Laboratory Corporation of America Holdings (Labcorp), Morrisville, North Carolina, USA
| | - Erwin Garcia
- Laboratory Corporation of America Holdings (Labcorp), Morrisville, North Carolina, USA
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Robin P F Dullaart
- Department of Internal Medicine, Division of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Lee TL, Hsuan CF, Wu CC, Hung WC, Tsai IT, Wei CT, Yu TH, Lu IC, Chung FM, Lee YJ, Lu YC. Association between Triglyceride Glucose Index and Corrected QT Prolongation in Chinese Male Steelworkers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084020. [PMID: 33921213 PMCID: PMC8069503 DOI: 10.3390/ijerph18084020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 01/08/2023]
Abstract
Objectives: Increased triglyceride glucose (TyG) index appears to be linked to carotid and coronary atherosclerosis and calcifications and possesses an elevated future risk of developing cardiovascular disease. Corrected QT (QTc) interval prolongation is associated with ventricular arrhythmias and sudden cardiac death, and a high prevalence of prolonged QTc interval was previously reported in blue-collar workers. The purpose of this study was to find the possible causal inter-relationship between TyG index and QTc interval in a large population of Chinese male steelworkers. Methods: A total of 3189 male workers from two steel plants were enrolled. They responded to a cross-sectional questionnaire on basic attributes and lifestyle, including sleep patterns. All workers in the two plants underwent periodic health checkups, including twelve-lead electrocardiography. Structural equation modeling (SEM) was used to assess the direct and indirect effects of TyG index on QTc interval. Results: With increasing TyG index tertile, the male steelworkers had an increased QTc interval. Applying multivariate analysis, TyG index was associated independently with the odds of QTc prolongation (adjusted odds ratio = 2.73, 95% confidence interval = 1.39–5.24, p = 0.004). SEM revealed that TyG index, hypertension, obesity, lifestyle, white blood cell (WBC) count, and liver function had statistically significant direct effects on QTc interval. Furthermore, TyG index also had an indirect effect on QTc interval through hypertension, obesity, WBC count, and liver function. Moreover, lifestyle had an indirect effect on QTc interval through TyG index. The final model explained 14% of the variability in QTc interval. Conclusions: An increased TyG index was associated with QTc interval prolongation in this study, and SEM delineated possible causal pathways and inter-relationships of the risk factors contributing to the occurrence of QTc prolongation among Chinese male steelworkers.
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Affiliation(s)
- Thung-Lip Lee
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan; (T.-L.L.); (C.-F.H.); (C.-C.W.); (W.-C.H.); (T.-H.Y.); (F.-M.C.)
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
| | - Chin-Feng Hsuan
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan; (T.-L.L.); (C.-F.H.); (C.-C.W.); (W.-C.H.); (T.-H.Y.); (F.-M.C.)
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
- Division of Cardiology, Department of Internal Medicine, E-Da Dachang Hospital, Kaohsiung 80794, Taiwan
| | - Cheng-Ching Wu
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan; (T.-L.L.); (C.-F.H.); (C.-C.W.); (W.-C.H.); (T.-H.Y.); (F.-M.C.)
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
| | - Wei-Chin Hung
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan; (T.-L.L.); (C.-F.H.); (C.-C.W.); (W.-C.H.); (T.-H.Y.); (F.-M.C.)
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
| | - I-Ting Tsai
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
- Department of Emergency, E-Da Hospital, Kaohsiung 82445, Taiwan
| | - Ching-Ting Wei
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
- Division of General Surgery, Department of Surgery, E-Da Hospital, Kaohsiung 82445, Taiwan
- Department of Biomedical Engineering, I-Shou University, Kaohsiung 82445, Taiwan
- Department of Electrical Engineering, I-Shou University, Kaohsiung 82445, Taiwan
| | - Teng-Hung Yu
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan; (T.-L.L.); (C.-F.H.); (C.-C.W.); (W.-C.H.); (T.-H.Y.); (F.-M.C.)
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
| | - I-Cheng Lu
- Department of Occupational Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan;
| | - Fu-Mei Chung
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan; (T.-L.L.); (C.-F.H.); (C.-C.W.); (W.-C.H.); (T.-H.Y.); (F.-M.C.)
| | - Yau-Jiunn Lee
- Lee’s Endocrinologic Clinic, Pingtung 90000, Taiwan;
| | - Yung-Chuan Lu
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
- Division of Endocrinology and Metabolism, Department of Internal Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan
- Correspondence:
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Bonifácio KL, Barbosa DS, Moreira EG, Coneglian CF, Vargas HO, Nunes SOV, Moraes JB, Maes M. Increased nitro-oxidative stress toxicity as a major determinant of increased blood pressure in mood disorders. J Affect Disord 2021; 278:226-238. [PMID: 32971315 DOI: 10.1016/j.jad.2020.09.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/31/2020] [Accepted: 09/07/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Hypertension, atherogenicity and insulin resistance are major risk factors of cardiovascular disorder (CVD), which shows a strong comorbidity with major depression (MDD) and bipolar disorder (BD). Activated oxidative and nitrosative stress (O&NS), inflammatory pathways, and increased atherogenicity are shared pathways underpinning CVD and mood disorders. METHODS The current study examined the effects of lipid hydroperoxides (LOOH), superoxide dismutase (SOD), nitric oxide metabolites (NOx), advanced oxidation protein products (AOPP), and malondialdehyde (MDA) on systolic (SBP) and diastolic (DBP) blood pressure in 96 mood disordered patients and 60 healthy controls. RESULTS A large part of the variance in SBP (31.6%) was explained by the regression on a z unit-weighted composite score (based on LOOH, AOPP, SOD, NOx) reflecting nitro-oxidative stress toxicity (NOSTOX), coupled with highly sensitive C-reactive protein, body weight and use of antihypertensives. Increased DBP was best predicted (23.8%) by body mass index and NOSTOX. The most important O&NS biomarkers predicting an increased SBP were in descending order of significance: LOOH, AOPP and SOD. Higher levels of the atherogenic index of plasma, HOMA2 insulin resistance index and basal thyroid-stimulating hormone also contributed to increased SBP independently from NOSTOX. Although there were no significant changes in SBP/DBP in mood disorders, the associations between NOSTOX and blood pressure were significant in patients with mood disorders but not in healthy controls. CONCLUSIONS Activated O&NS pathways including increased lipid peroxidation and protein oxidation, which indicates hypochlorous stress, are the most important predictors of an increased BP, especially in patients with mood disorders.
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Affiliation(s)
- Kamila Landucci Bonifácio
- Graduation Program in Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil; Laboratory of Graduation Program in Health Sciences, State University of Londrina, Londrina, PR, Brazil
| | - Décio Sabbatini Barbosa
- Graduation Program in Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil; Department of Clinical Analysis and Toxicological, State University of Londrina, Brazil; Laboratory of Graduation Program in Health Sciences, State University of Londrina, Londrina, PR, Brazil
| | | | - Carine Farias Coneglian
- Graduation Program in Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil; Laboratory of Graduation Program in Health Sciences, State University of Londrina, Londrina, PR, Brazil
| | - Heber Odebrecht Vargas
- Department of Psychiatry, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil.
| | - Sandra Odebrecht Vargas Nunes
- Laboratory of Graduation Program in Health Sciences, State University of Londrina, Londrina, PR, Brazil; Department of Psychiatry, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil.
| | - Juliana Brum Moraes
- Graduation Program in Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria; IMPACT Strategic Research Centre, Deakin University, Geelong, VIC, Australia.
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Lin YT, Salihovic S, Fall T, Hammar U, Ingelsson E, Ärnlöv J, Lind L, Sundström J. Global Plasma Metabolomics to Identify Potential Biomarkers of Blood Pressure Progression. Arterioscler Thromb Vasc Biol 2020; 40:e227-e237. [DOI: 10.1161/atvbaha.120.314356] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective:
The pathophysiology of hypertension remains incompletely understood. We investigated associations of circulating metabolites with longitudinal blood pressure (BP) changes in the Prospective Investigation of the Vasculature in Uppsala Seniors cohort and validated the findings in the Uppsala Longitudinal Study of Adult Men cohort.
Approach and Results:
Circulating metabolite levels were assessed with liquid- and gas-chromatography coupled to mass spectrometry among persons without BP-lowering medication at baseline. We studied associations of baseline levels of metabolites with changes in BP levels and the clinical BP stage between baseline and a follow-up examination 5 years later. In the discovery cohort, we investigated 504 individuals that contributed with 757 observations of paired BP measurements. The mean baseline systolic and diastolic BPs were 144 (19.7)/76 (9.7) mm Hg, and change in systolic and diastolic BPs were 3.7 (15.8)/−0.5 (8.6) mm Hg over 5 years. The metabolites associated with diastolic BP change were ceramide, triacylglycerol, total glycerolipids, oleic acid, and cholesterylester. No associations with longitudinal changes in systolic BP or BP stage were observed. Metabolites with similar structures to the 5 top findings in the discovery cohort were investigated in the validation cohort. Diacylglycerol (36:2) and monoacylglycerol (18:0), 2 glycerolipids, were associated with diastolic BP change in the validation cohort.
Conclusions:
Circulating baseline levels of ceramide, triacylglycerol, total glycerolipids, and oleic acid were positively associated with longitudinal diastolic BP change, whereas cholesterylester levels were inversely associated with longitudinal diastolic BP change. Two glycerolipids were validated in an independent cohort. These metabolites may point towards pathophysiological pathways of hypertension.
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Affiliation(s)
- Yi-Ting Lin
- From the Department of Medical Sciences, Uppsala University, Sweden (Y.-T.L., S.S., T.F., U.H., E.I., L.L., J.S.)
- Department of Family Medicine, Kaohsiung Medical University Hospital (Y.-T.L.), Kaohsiung Medical University, Taiwan
- Faculty of Medicine, College of Medicine (Y.-T.L.), Kaohsiung Medical University, Taiwan
| | - Samira Salihovic
- From the Department of Medical Sciences, Uppsala University, Sweden (Y.-T.L., S.S., T.F., U.H., E.I., L.L., J.S.)
- School of Medical Sciences (S.S.), Örebro University, Sweden
- School of Science and Technology (S.S.), Örebro University, Sweden
| | - Tove Fall
- From the Department of Medical Sciences, Uppsala University, Sweden (Y.-T.L., S.S., T.F., U.H., E.I., L.L., J.S.)
| | - Ulf Hammar
- From the Department of Medical Sciences, Uppsala University, Sweden (Y.-T.L., S.S., T.F., U.H., E.I., L.L., J.S.)
| | - Erik Ingelsson
- From the Department of Medical Sciences, Uppsala University, Sweden (Y.-T.L., S.S., T.F., U.H., E.I., L.L., J.S.)
- Division of Cardiovascular Medicine, Department of Medicine (E.I.), Stanford University School of Medicine, CA
- Stanford Cardiovascular Institute (E.I.), Stanford University School of Medicine, CA
- Stanford Diabetes Research Center (E.I.), Stanford University School of Medicine, CA
| | - Johan Ärnlöv
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden (J.Ä.)
- School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.)
| | - Lars Lind
- From the Department of Medical Sciences, Uppsala University, Sweden (Y.-T.L., S.S., T.F., U.H., E.I., L.L., J.S.)
| | - Johan Sundström
- From the Department of Medical Sciences, Uppsala University, Sweden (Y.-T.L., S.S., T.F., U.H., E.I., L.L., J.S.)
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia (J.S.)
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Association of triglycerides to high-density lipoprotein-cholesterol ratio with risk of incident hypertension. Hypertens Res 2020; 43:948-955. [PMID: 32332924 DOI: 10.1038/s41440-020-0439-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 12/12/2022]
Abstract
The triglyceride to high-density lipoprotein-cholesterol (TG/HDL-C) ratio is considered a simple surrogate of insulin resistance. The aim of this study was to explore the association of the TG/HDL-C ratio with the risk of incident hypertension and whether the TG/HDL-C ratio mediates the obesity-incident hypertension association. The study analyzed 9679 participants from a rural Chinese population. Demographic and anthropometric and laboratory data were collected at baseline (2007-2008) and follow-up (2013-2014) examinations. A multivariate logistic regression model was used to analyze the association of the TG/HDL-C ratio with incident hypertension, estimating odds ratios (ORs) and 95% confidence intervals (CIs). Mediation analysis was performed to examine the contribution of the TG/HDL-C ratio to obesity-related incident hypertension. During a median follow-up of 6.00 years, hypertension developed in 1880/9679 participants (19.42%). The risk of incident hypertension was higher in the highest TG/HDL-C ratio quartile than in the lowest quartile (OR = 1.21, 95% CI = 1.02-1.42). Subgroup analyses showed that the risk of incident hypertension was increased by 30%, 36%, and 33% among women, participants < 60 years old and those with prehypertension at baseline, respectively. The TG/HDL-C ratio partially mediated the obesity-incident hypertension association (indirect effect: OR = 1.04, 95% CI: 1.01-1.07; direct effect: OR = 1.36, 95% CI: 1.16-1.62). The TG/HDL-C ratio may be a risk factor for incident hypertension, especially in women, participants < 60 years old and those with prehypertension. The TG/HDL-C ratio may also play a mediating role in obesity-related incident hypertension.
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Liu XZ, Fan J, Pan SJ. METS-IR, a novel simple insulin resistance indexes, is associated with hypertension in normal-weight Chinese adults. J Clin Hypertens (Greenwich) 2019; 21:1075-1081. [PMID: 31282098 DOI: 10.1111/jch.13591] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/29/2019] [Accepted: 05/09/2019] [Indexed: 12/14/2022]
Abstract
Insulin resistance (IR) plays a crucial role in the development of hypertension, so early recognition of IR is of substantial clinical importance for the management of hypertension. But traditional IR indexes are invasive, complex, and impractical. We aimed to evaluate the associations between three simple IR indexes and hypertension in different body mass index (BMI) categories. A total of 142 005 adults who did not take antihypertensive medication were included in this analysis. The ratio of triglycerides to high-density lipoprotein cholesterol (TG/HDLc), the product of fasting triglycerides and glucose (TyG), and metabolic score for IR (METS-IR) were calculated according to the corresponding formulas. The associations between them and hypertension were analyzed by logistic regression. Among the three indicators, only METS-IR had positive correlations with blood pressure levels (all P < 0.001). After full adjustment, METS-IR was significantly associated with hypertension in the normal BMI group but not in the elevated BMI group. The OR for hypertension in the normal BMI group in the highest quartile of METS-IR was 2.884 (95% CI: 2.468-3.369) in the total sample, 1.915 (95% CI: 1.614-2.271) in females and 2.083 (95% CI: 1.717-2.527) in males. Our findings indicate that METS-IR, a simple and cost-effective IR index, was strongly associated with hypertension in normal-weight Chinese subjects. It could help monitor and manage hypertension in normal-weight individuals.
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Affiliation(s)
- Xing Zhen Liu
- Directly Affiliated Convalescence Area, Hangzhou Aeronautical Sanatorium of Chinese Air Force, Hangzhou, China
| | - Jie Fan
- General Management Office, Zhejiang Police College, Hangzhou, China
| | - Shu Jun Pan
- Directly Affiliated Convalescence Area, Hangzhou Aeronautical Sanatorium of Chinese Air Force, Hangzhou, China
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10
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Kabootari M, Akbarpour S, Azizi F, Hadaegh F. Sex specific impact of different obesity phenotypes on the risk of incident hypertension: Tehran lipid and glucose study. Nutr Metab (Lond) 2019; 16:16. [PMID: 30858870 PMCID: PMC6391753 DOI: 10.1186/s12986-019-0340-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 02/11/2019] [Indexed: 12/13/2022] Open
Abstract
Background To investigate the association between different obesity phenotypes and the risk of incident hypertension among both genders. Methods The study population included 3659 Iranians (men = 1540), aged ≥20 years free of hypertension at baseline. Participants were classified into six categories of body mass index (BMI)-metabolic health status, in which unhealthy metabolic status was defined based on the presence of > 1 component of metabolic syndrome (MetS) using the joint interim statement (JIS) criteria or the presence of insulin resistance (IR). The association between different obesity phenotypes and incident hypertension was assessed using multivariate Cox's proportional hazard models adjusted for age, current smoking, low physical activity, diabetes mellitus, family history of premature cardiovascular disease, estimated glomerular filtration rate, phase of recruitment, BMI and systolic blood pressure, considering metabolically healthy normal weight group as the reference. Results After a median follow-up of 11.6 years 1122 participants (men = 493) experienced hypertension. Using JIS criteria, a significant higher risk of hypertension was observed among metabolically healthy obese and well as metabolically unhealthy groups among men in the age adjusted model; however, a significant higher risk in the fully adjusted model was seen among women in the metabolically healthy obese [hazard ratio (HR) 95% confidence interval (CI) 1.96(1.16-3.32)] as well as metabolically unhealthy normal weight [1.98(1.37-2.86)], overweight [2.08(1.49-2.90)] and obese [2.06(1.27-3.30)] groups. Using insulin sensitive normal weight group as the reference, among men, being overweight or obese with and without IR was significant predictors of incident hypertension in the age adjusted model; however, among women, insulin resistant overweight [1.46(1.06-2.02)] and obese groups, [1.63(1.01-2.62)] showed significant risk in the fully adjusted model. Conclusion We concluded that first, there was significant difference between genders in the associations between obesity phenotypes and incident hypertension. Second, in general, metabolic status defined by MetS components as compared to IR could do better in identifying high risk women for hypertension. Third, women populations who are metabolically healthy obese using MetS definition or those with either > 1 component of metabolic syndrome or overweight/obese ones with IR should be prioritized for implementing urgent preventive strategies against hypertension focusing on lifestyle changes.
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Affiliation(s)
- Maryam Kabootari
- 1Metabolic Disorders Research Center, Golestan university of Medical Sciences, Gorgan, Iran.,2Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, No. 24, Parvaneh Street, Velenjak, Tehran, Iran
| | - Samaneh Akbarpour
- 3Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- 4Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- 2Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, No. 24, Parvaneh Street, Velenjak, Tehran, Iran
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11
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Zheng R, Mao Y. Triglyceride and glucose (TyG) index as a predictor of incident hypertension: a 9-year longitudinal population-based study. Lipids Health Dis 2017; 16:175. [PMID: 28903774 PMCID: PMC5598027 DOI: 10.1186/s12944-017-0562-y] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 09/04/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Hypertension and the triglyceride and glucose index both have been associated with insulin resistance; however, the longitudinal association remains unclear. This study was designed to investigate the longitudinal association between the triglyceride and glucose index and incident hypertension among the Chinese population. METHODS We studied 4686 subjects (3177 males and 1509 females) and followed up for 9 years. The subjects were divided into four groups based on the triglyceride and glucose index. Univariate and multivariate Cox regression models were used to analyse the risk factors of hypertension. RESULTS After 9 years of follow-up, 2047 subjects developed hypertension. The overall 9-year cumulative incidence of hypertension was 43.7%, ranging from 28.5% in quartile 1 to 36.9% in quartile 2, 49.2% in quartile 3 and 59.8% in quartile 4 (p for trend < 0.001). Cox regression analyses indicated that higher triglyceride and glucose index was associated with an increased risk of subsequent incident hypertension. CONCLUSION The triglyceride and glucose index can predict the incident hypertension among the Chinese population.
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Affiliation(s)
- Rongjiong Zheng
- Department of Endocrinology, the Affiliated Hospital of Ningbo University School of Medicine, 247 Renmin Road, Ningbo, 315020, China. .,Ningbo University, Ningbo, China.
| | - Yushan Mao
- Department of Endocrinology, the Affiliated Hospital of Ningbo University School of Medicine, 247 Renmin Road, Ningbo, 315020, China. .,Ningbo University, Ningbo, China.
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12
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Dong H, Xu Y, Zhang X, Tian S. Visceral adiposity index is strongly associated with hyperuricemia independently of metabolic health and obesity phenotypes. Sci Rep 2017; 7:8822. [PMID: 28821853 PMCID: PMC5562916 DOI: 10.1038/s41598-017-09455-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 07/25/2017] [Indexed: 12/22/2022] Open
Abstract
Visceral adiposity index (VAI) is a novel sex-specific index for visceral adipose function; however the association between VAI and hyperuricemia in China is unknown. We aimed to investigate this association, also whether it was independent of metabolic health and obesity phenotypes. 7632 adult subjects from the China Health and Nutrition Survey 2009 were retained. Subjects were categorized into four obesity phenotypes based on a cross-classification of BMI and metabolic health status by two representative criteria. VAI was the best predictors for hyperuricemia irrespective of obesity phenotypes, with area under curve (AUC) ranging 0.665–0.719. The odd ratio (OR) for hyperuricemia in the highest quartile of the VAI were 6.93 (95% CI 5.79–8.29) after adjusting for age and gender. Following further adjustments for metabolic obesity phenotypes and lifestyle confounders, the ORs were 4.88 (3.92–6.09) and 5.65 (4.68–6.82) according to these two criteria, respectively. A similar significant pattern was still found even after adjustment for blood pressure and other cardiovascular risks. Within each metabolic obesity phenotype, the significant association between VAI and hyperuricemia was consistently evident. In conclusion, the association of the VAI with hyperuricemia was significant, especially this association was independent of metabolic health and obesity phenotypes in the Chinese population.
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Affiliation(s)
- Huimin Dong
- Department of Clinical Nutrition and Metabolism, Affiliated Zhongshan Hospital of Dalian University, NO. 6 Jiefang Street Zhongshan District, Dalian, Liaoning Province, 116001, People's Republic of China
| | - Yang Xu
- Department of Scientific Research Project, Affiliated Zhongshan Hospital of Dalian University, NO. 6 Jiefang Street Zhongshan District, Dalian, Liaoning Province, 116001, People's Republic of China
| | - Xiuzhi Zhang
- Department of Scientific Research Project, Affiliated Zhongshan Hospital of Dalian University, NO. 6 Jiefang Street Zhongshan District, Dalian, Liaoning Province, 116001, People's Republic of China
| | - Simiao Tian
- Department of Scientific Research Project, Affiliated Zhongshan Hospital of Dalian University, NO. 6 Jiefang Street Zhongshan District, Dalian, Liaoning Province, 116001, People's Republic of China.
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Zhang YM, Wang J, Liu XG. Association between hypertension and risk of knee osteoarthritis: A meta-analysis of observational studies. Medicine (Baltimore) 2017; 96:e7584. [PMID: 28796041 PMCID: PMC5556207 DOI: 10.1097/md.0000000000007584] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Evidence from observational studies shows that hypertension may be a risk factor for knee osteoarthritis (OA). However, the relationship between hypertension and knee OA risk remains controversial. This study aimed to quantitatively assess the relationship between hypertension and risk of knee OA.Three electronic databases (PubMed, Embase, and Cochrane Library) were searched up to July 25, 2016. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were extracted from the included observational studies. Publication bias, heterogeneity test, and subgroup analyses were performed.Eight studies including 2 cohort studies and 6 cross-sectional studies with 9762 participants were finally included in this meta-analysis. The results showed that hypertension was significantly associated with higher radiographic knee OA and symptomatic knee OA risks of 2.01 (95% CI, 1.28-3.15, I = 90.2%, P for heterogeneity <.001) and 1.49 (95% CI, 1.26-1.77, I = 0%, P for heterogeneity <.412), respectively. No publication bias was detected. The subgroup analysis showed that the study design did not influence the results (radiographic knee OA: OR = 1.42, 95% CI, 1.19-1.71 for cross-sectional studies and OR = 2.17, 95% CI, 1.30-3.63 for cohort studies; and symptomatic knee OA: OR = 1.85, 95% CI, 1.10-3.13) for cross-sectional studies and OR = 2.74, 95% CI, 1.81-4.16 for cohort studies).This meta-analysis showed that there was a significant relationship between hypertension and knee OA (both radiographic and symptomatic). However, further original studies are needed that use a better design.
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Affiliation(s)
- Yi-min Zhang
- Department of Orthopedic, Wei Fang People's Hospital
| | - Jun Wang
- Department of Orthopedic, Wei Fang People's Hospital
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Wang F, Han L, Hu D. Fasting insulin, insulin resistance and risk of hypertension in the general population: A meta-analysis. Clin Chim Acta 2016; 464:57-63. [PMID: 27836689 DOI: 10.1016/j.cca.2016.11.009] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/06/2016] [Accepted: 11/06/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Studies on the association of fasting insulin concentrations or insulin resistance with subsequent risk of hypertension have yielded conflicting results. OBJECTIVE To quantitatively assess the association of fasting insulin concentrations or homeostasis model assessment insulin resistance (HOMA-IR) with incident hypertension in a general population by performing a meta-analysis. METHODS We searched the PubMed and Embase databases until August 31, 2016 for prospective observational studies investigating the elevated fasting insulin concentrations or HOMA-IR with subsequent risk of hypertension in the general population. Pooled risk ratio (RR) and 95% confidence interval (CI) of hypertension was calculated for the highest versus the lowest category of fasting insulin or HOMA-IR. RESULTS Eleven studies involving 10,230 hypertension cases were identified from 55,059 participants. Meta-analysis showed that the pooled adjusted RR of hypertension was 1.54 (95% CI 1.34-1.76) for fasting insulin concentrations and 1.43 (95% CI 1.27-1.62) for HOMA-IR comparing the highest to the lowest category. Subgroup analysis results showed that the association of fasting insulin concentrations with subsequent risk of hypertension seemed more pronounced in women (RR 2.07; 95% CI 1.19-3.60) than in men (RR 1.48; 95% CI 1.17-1.88). CONCLUSIONS This meta-analysis suggests that elevated fasting insulin concentrations or insulin resistance as estimated by homeostasis model assessment is independently associated with an exacerbated risk of hypertension in the general population. Early intervention of hyperinsulinemia or insulin resistance may help clinicians to identify the high risk of hypertensive population.
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Affiliation(s)
- Feng Wang
- Department of Cardiology, The Frist Affiliated Hospital of Chongqing Medical University, Chongqing, China, 400016
| | - Lili Han
- Department of Emergency, Zoucheng People's Hospital, Zoucheng, Shandong Province, China, 273500
| | - Dayi Hu
- Department of Cardiology, The Frist Affiliated Hospital of Chongqing Medical University, Chongqing, China, 400016.
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Zhang T, Li Y, Zhang H, Sun D, Li S, Fernandez C, Harville E, Bazzano L, He J, Chen W. Insulin-sensitive adiposity is associated with a relatively lower risk of diabetes than insulin-resistant adiposity: the Bogalusa Heart Study. Endocrine 2016; 54:93-100. [PMID: 27060004 PMCID: PMC7502025 DOI: 10.1007/s12020-016-0948-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/30/2016] [Indexed: 11/30/2022]
Abstract
Obesity and insulin resistance are both closely associated with type 2 diabetes mellitus (T2DM). It is, however, not clear whether the role of obesity in the development of T2DM is dependent on insulin resistance. This study aims to assess the hypothesis that insulin-sensitive adiposity is associated with a relatively lower risk of T2DM than insulin-resistant adiposity, and the adiposity-T2DM association is modified by insulin resistance in middle-aged black and white adults. The longitudinal study cohort consisted of 1588 middle-aged normoglycemic black and white adults aged 18-44 years at baseline who were followed for 16 years on average. Overweight/obesity at baseline was defined as BMI ≥25, and insulin resistance was measured using the homeostasis model assessment of insulin resistance (HOMA). The prevalence of incident pre-diabetes and T2DM was compared between the insulin-sensitive and insulin-resistant adiposity groups. The prevalence of both incident pre-diabetes and T2DM was higher in the insulin-resistant adiposity than in the insulin-sensitive adiposity group (11.5 vs. 7.5 %, p = 0.023 for pre-diabetes; 16.7 vs. 2.7 %, p < 0.001 for T2DM). In multivariable logistic analyses, adjusted for baseline age, race, sex, follow-up years, and smoking, baseline insulin-resistant obesity was associated with incident pre-diabetes (odds ratio, OR = 2.07, p = 0.046) and T2DM (OR = 8.19, p < 0.001). ORs did not differ between blacks and whites. The ORs for the association of BMI with pre-diabetes and T2DM significantly increased across increasing quartiles of baseline HOMA (p for trend = 0.032 for pre-diabetes and <0.001 for T2DM). Slopes of increasing follow-up glucose with baseline BMI, measured as regression coefficients (β), were significantly greater in insulin-resistant than in insulin-sensitive individuals (β = 0.86 vs. 0.38, p = 0.009 for difference in slopes). These findings suggest that insulin resistance amplifies the obesity-diabetes association and underscore the importance of preventing both adiposity and insulin resistance in young adults.
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Affiliation(s)
- Tao Zhang
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, China
- Department of Epidemiology, Tulane University Health Sciences Center, Tulane University, 1440 Canal Street, Room 1504G, New Orleans, LA, 70112, USA
| | - Ying Li
- Department of Epidemiology, Tulane University Health Sciences Center, Tulane University, 1440 Canal Street, Room 1504G, New Orleans, LA, 70112, USA
- Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, China
| | - Huijie Zhang
- Department of Epidemiology, Tulane University Health Sciences Center, Tulane University, 1440 Canal Street, Room 1504G, New Orleans, LA, 70112, USA
- Department of Endocrinology and Metabolism, The First Hospital of Xiamen, Xiamen University, Xiamen, China
| | - Dianjianyi Sun
- Department of Epidemiology, Tulane University Health Sciences Center, Tulane University, 1440 Canal Street, Room 1504G, New Orleans, LA, 70112, USA
| | - Shengxu Li
- Department of Epidemiology, Tulane University Health Sciences Center, Tulane University, 1440 Canal Street, Room 1504G, New Orleans, LA, 70112, USA
| | - Camilo Fernandez
- Department of Epidemiology, Tulane University Health Sciences Center, Tulane University, 1440 Canal Street, Room 1504G, New Orleans, LA, 70112, USA
| | - Emily Harville
- Department of Epidemiology, Tulane University Health Sciences Center, Tulane University, 1440 Canal Street, Room 1504G, New Orleans, LA, 70112, USA
| | - Lydia Bazzano
- Department of Epidemiology, Tulane University Health Sciences Center, Tulane University, 1440 Canal Street, Room 1504G, New Orleans, LA, 70112, USA
| | - Jiang He
- Department of Epidemiology, Tulane University Health Sciences Center, Tulane University, 1440 Canal Street, Room 1504G, New Orleans, LA, 70112, USA
| | - Wei Chen
- Department of Epidemiology, Tulane University Health Sciences Center, Tulane University, 1440 Canal Street, Room 1504G, New Orleans, LA, 70112, USA.
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16
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Zhang T, Zhang H, Li Y, Sun D, Li S, Fernandez C, Qi L, Harville E, Bazzano L, He J, Xue F, Chen W. Temporal Relationship Between Childhood Body Mass Index and Insulin and Its Impact on Adult Hypertension: The Bogalusa Heart Study. Hypertension 2016; 68:818-23. [PMID: 27432860 DOI: 10.1161/hypertensionaha.116.07991] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 06/28/2016] [Indexed: 12/22/2022]
Abstract
Although obesity and insulin resistance are closely correlated, their temporal sequences in early life and influence on adult hypertension are largely unknown. This study aims to delineate the temporal relationship patterns between body mass index (BMI) and insulin in childhood and their impact on adult hypertension. The longitudinal cohort consisted of 990 adults (630 whites and 360 blacks) who had BMI and fasting insulin measured twice 5.4 years apart in childhood (mean age, 10.5 years at baseline and 15.9 years at follow-up) and blood pressure measured 14.7 years later in adulthood (mean age, 30.5 years). Cross-lagged panel and mediation analysis models were used to examine the temporal relationship between childhood BMI and insulin and its impact on adult hypertension. After adjusting for age, race, sex, and follow-up years, the cross-lagged path coefficient (β=0.33; P<0.001) from baseline BMI to follow-up insulin was significantly greater than the path coefficient (β=-0.02; P>0.05) from baseline insulin to follow-up BMI in childhood with P<0.001 for the difference in βs. Blacks and whites showed similar patterns of the temporal relationship. The path coefficient (β=0.59; P<0.001) from BMI to insulin in the hypertensive group was significantly greater than that (β=0.24; P<0.001) in normotensive group, with P<0.001 for the difference in βs between these 2 groups. The mediation effect of childhood insulin on the childhood BMI-adult hypertension association was estimated at 21.1% (P<0.001). These findings provide evidence that higher BMI levels precede hyperinsulinemia during childhood, and this 1-directional relation plays a role in the development of hypertension.
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Affiliation(s)
- Tao Zhang
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.)
| | - Huijie Zhang
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.)
| | - Ying Li
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.)
| | - Dianjianyi Sun
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.)
| | - Shengxu Li
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.)
| | - Camilo Fernandez
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.)
| | - Lu Qi
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.)
| | - Emily Harville
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.)
| | - Lydia Bazzano
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.)
| | - Jiang He
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.)
| | - Fuzhong Xue
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.).
| | - Wei Chen
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.).
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Zhang T, Zhang H, Li S, Li Y, Liu Y, Fernandez C, Harville E, Bazzano L, He J, Chen W. Impact of Adiposity on Incident Hypertension Is Modified by Insulin Resistance in Adults: Longitudinal Observation From the Bogalusa Heart Study. Hypertension 2015; 67:56-62. [PMID: 26573703 DOI: 10.1161/hypertensionaha.115.06509] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 10/21/2015] [Indexed: 01/29/2023]
Abstract
Adiposity and insulin resistance are closely associated with hypertension. This study aims to investigate whether the association between adiposity and hypertension is modified by insulin resistance. The cohort consisted of 1624 middle-aged normotensive black and white adults aged 18 to 43 years at baseline who followed for 16 years on average. Overweight/obesity at baseline was defined as body mass index (BMI) ≥25, and insulin resistance was measured using homeostasis model assessment of insulin resistance. Prevalence of incident hypertension was compared between the insulin-sensitive adiposity and insulin-resistant adiposity groups. The prevalence of incident hypertension was higher in the insulin-resistant adiposity than in the insulin-sensitive adiposity group (32.1% versus 22.1%, P<0.001). In multivariable logistic analyses, adjusted for baseline age, race, sex, follow-up years, and smoking, baseline insulin-resistant obesity was associated with incident hypertension (odds ratio, 1.9; P=0.008). Odds ratios did not differ between blacks and whites (P=0.238). Of note, the odds ratios of BMI associated with hypertension significantly increased with increasing quartiles of baseline homeostasis model assessment (odds ratio, 1.3, 1.1, 1.5, and 2.5 in quartiles I, II, III, and IV, respectively; P=0.006 for trend). Slopes of increasing follow-up blood pressure with baseline BMI, measured as regression coefficients (β), were significantly greater in insulin-resistant than in insulin-sensitive individuals (β=0.74 versus β=0.35 for systolic blood pressure, P=0.004 for difference; β=0.51 versus β=0.23 for diastolic blood pressure, P=0.001 for difference). These findings suggest that insulin resistance has a synergistic effect on the obesity-hypertension association in young adults, indicating that the role of adiposity in the development of hypertension is modified by insulin resistance.
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Affiliation(s)
- Tao Zhang
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z.); Departments of Epidemiology (T.Z., H.Z., S.L., C.F., E.H., L.B., J.H., W.C.) and Biostatistics and Bioinformatics (Y. Liu), Tulane University Health Sciences Center, Tulane University, New Orleans, LA; Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, Xiamen, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, China (Y. Li)
| | - Huijie Zhang
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z.); Departments of Epidemiology (T.Z., H.Z., S.L., C.F., E.H., L.B., J.H., W.C.) and Biostatistics and Bioinformatics (Y. Liu), Tulane University Health Sciences Center, Tulane University, New Orleans, LA; Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, Xiamen, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, China (Y. Li)
| | - Shengxu Li
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z.); Departments of Epidemiology (T.Z., H.Z., S.L., C.F., E.H., L.B., J.H., W.C.) and Biostatistics and Bioinformatics (Y. Liu), Tulane University Health Sciences Center, Tulane University, New Orleans, LA; Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, Xiamen, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, China (Y. Li)
| | - Ying Li
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z.); Departments of Epidemiology (T.Z., H.Z., S.L., C.F., E.H., L.B., J.H., W.C.) and Biostatistics and Bioinformatics (Y. Liu), Tulane University Health Sciences Center, Tulane University, New Orleans, LA; Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, Xiamen, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, China (Y. Li)
| | - Yaozhong Liu
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z.); Departments of Epidemiology (T.Z., H.Z., S.L., C.F., E.H., L.B., J.H., W.C.) and Biostatistics and Bioinformatics (Y. Liu), Tulane University Health Sciences Center, Tulane University, New Orleans, LA; Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, Xiamen, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, China (Y. Li)
| | - Camilo Fernandez
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z.); Departments of Epidemiology (T.Z., H.Z., S.L., C.F., E.H., L.B., J.H., W.C.) and Biostatistics and Bioinformatics (Y. Liu), Tulane University Health Sciences Center, Tulane University, New Orleans, LA; Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, Xiamen, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, China (Y. Li)
| | - Emily Harville
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z.); Departments of Epidemiology (T.Z., H.Z., S.L., C.F., E.H., L.B., J.H., W.C.) and Biostatistics and Bioinformatics (Y. Liu), Tulane University Health Sciences Center, Tulane University, New Orleans, LA; Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, Xiamen, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, China (Y. Li)
| | - Lydia Bazzano
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z.); Departments of Epidemiology (T.Z., H.Z., S.L., C.F., E.H., L.B., J.H., W.C.) and Biostatistics and Bioinformatics (Y. Liu), Tulane University Health Sciences Center, Tulane University, New Orleans, LA; Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, Xiamen, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, China (Y. Li)
| | - Jiang He
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z.); Departments of Epidemiology (T.Z., H.Z., S.L., C.F., E.H., L.B., J.H., W.C.) and Biostatistics and Bioinformatics (Y. Liu), Tulane University Health Sciences Center, Tulane University, New Orleans, LA; Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, Xiamen, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, China (Y. Li)
| | - Wei Chen
- From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z.); Departments of Epidemiology (T.Z., H.Z., S.L., C.F., E.H., L.B., J.H., W.C.) and Biostatistics and Bioinformatics (Y. Liu), Tulane University Health Sciences Center, Tulane University, New Orleans, LA; Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, Xiamen, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, China (Y. Li).
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18
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Hypertension outcomes in metabolically unhealthy normal-weight and metabolically healthy obese children and adolescents. J Hum Hypertens 2015; 29:548-54. [PMID: 25652533 DOI: 10.1038/jhh.2014.124] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 11/13/2014] [Accepted: 11/19/2014] [Indexed: 12/31/2022]
Abstract
Metabolically healthy obesity (MHO) begins in childhood and continues into adulthood. However, the association between MHO and the risk of developing hypertension remains controversial. A prospective cohort study was conducted to investigate the risk of hypertension in MHO and metabolically unhealthy normal-weight (MUNW) Chinese children and adolescents. A total of 1183 participants, 6-18 years old at baseline with normal blood pressure values, were studied using follow-up data from the cohort of the Beijing Child and Adolescent Metabolic Syndrome (BCAMS) study. The participants were classified according to the body mass index and the presence/absence of metabolic abnormality, which was defined by metabolic syndrome (MetS) or insulin resistance (IR). During the 6-year follow-up period, 239 (20.2%) participants developed incident hypertension. After adjusting for age, sex, physical activity, pubertal stage, dietary habits and family history of hypertension, an increased risk for hypertension was observed in the MHO individuals (risk ratio, RRMetS 5.42; 95% confidence interval (CI) 3.19-9.22 and RRIR 7.59; 95% CI 1.64-35.20) compared with their metabolically healthy normal-weight counterparts. Independent of the definition of metabolic abnormality, the MUNW subjects did not have an elevated incidence of hypertension. These results suggest that the risk of developing hypertension is increased in the MHO but not in the MUNW individuals.
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